Évolution de la densité minérale osseuse chez des hommes ostéoporotiques et hypercalciuriques traités par diurétiques thiazidiques

Abstract

A few studies suggest that thiazide diuretic agents may have modest beneficial effects on bone. Few data are available on the effects of these medications in patients with osteoporosis and hypercalciuria. Objective. – To evaluate the effects of thiazide diuretic therapy on bone mass and urinary calcium excretion in hypercalciuretic osteoporotic male patients. Patients and methods. – Osteoporosis was defined as a greater than 2.5 standard-deviation decrease in bone mineral density (BMD) at the lumbar spine or hip (T score) We used an open-label prospective design to compare 14 patients with hypercalciuretic osteoporosis treated with a thiazide diuretic for 18 months and 13 patients with primary osteoporosis treated with calcium and vitamin D supplementation. Mean age was 53.5 ± 9.6 years in the thiazide group and 48.7 ± 8.4 years in the calcium–vitamin D supplementation group. The following serum parameters were assayed at baseline: 25 OH-D3, 1,25 OH-D3, parathyroid hormone (PTH), and bone turnover markers. Urinary calcium excretion and BMD by dual-energy X-ray absorptiometry at the spine and hip were determined at baseline and after 18 months of treatment. Results. – Annual BMD increases were similar in the two groups during the 18-month treatment period: lumbar spine, 0.6% ± 2.5% ( P = 0.47) in the thiazide group and 0.004% ± 3% ( P = 0.78) in the supplementation group; femoral neck, 0.47% ± 2.6% ( P = 0.89) and 1.1% ± 3.2% ( P = 0.22); total hip, 0.65% ± 2.5% ( P = 0.37) and 0.12% ± 2.1% ( P = 0.51). Urinary calcium excretion fell by 45.9% in the thiazide group from baseline to study completion ( P = 0.0015). Conclusion. – We found no evidence that thiazide therapy increased bone mass in patients with hypercalciuria and osteoporosis as compared to calcium–vitamin D supplementation in patients with osteoporosis but no hypercalciuria. In contrast, our results establish the efficacy of thiazide diuretics in reducing urinary calcium excretion, an effect that may decrease the risk of urinary lithiasis. Studies in larger patient cohorts treated for longer periods are needed to confirm or refute our findings.